Does it look like I would be suited with a fleur de lis tummy tuck or a regular 360? (Photo)

Question

I''m 37, 5'10, 155lbs. At my worst I was I was 280lbsIt's not the first time I've gained and lost weight. I've consulted with about 5 different surgeons, and no one ever mentioned my needing a fleur de lis 360 procedure until the final consult, with the surgeon I like the most. He only said that my result would be 20-30% better, but it's my choice. Does it really look like it would make that much of an improvement given the extra scar?

Ozge Ergun, MD · Answer

"The degree of sagging skin above the belly button is not extreme, and your chest condition appears to be satisfactory. Therefore, I do not recommend the Fleur-de-Lis technique, as it would result in a significant scar. Instead, a belt lift would be a more suitable option, as it allows for better scar concealment while achieving a smoother, tighter, and more contoured result."

J. Timothy Katzen, MD, FACS · Answer

Hello, and thank you for your question regarding whether a fleur-de-lis tummy tuck or a regular 360 body lift would be better for your situation.

By looking at your photos, I believe you will achieve excellent results with a 360 body lift alone. The vertical scar from a fleur-de-lis procedure is not necessary in your case to achieve a transformative outcome. The 360 body lift will address the excess skin and fat around your abdomen, hips, and back, providing a contoured and sculpted look.

While a fleur-de-lis procedure can provide additional tightening for patients with significant vertical skin laxity, your photos suggest that your skin elasticity and current contour would respond beautifully to the 360 body lift. The absence of a vertical scar is also a significant aesthetic advantage, especially if the improvement it might bring is relatively minor in your case.

If you prefer not to have the vertical scar and your goal is to achieve dramatic yet natural results, I recommend proceeding with the 360 body lift. You’re likely to be very pleased with the outcome. Be sure to discuss all your concerns and goals with your chosen surgeon to ensure the best approach for you.

Congratulations on your weight loss journey, and I hope this helps guide your decision!

Sincerely,
Dr. Katzen

Finny George, MD · Answer

Hi, thank you for sharing your question. Based on the photos, you seem to be a good candidate for abdominoplasty without the need for a fleur-de-lis. An in-person evaluation will help.

Daniel Barrett, MD · Answer

Dear tssotsgt,

based on your photos, you look like a good candidate for a TT. Full tummy tuck should tighten your abdominal muscles and remove the excess skin. Flanks liposuction would give you a better shape. I would suggest you to consult a board-certified plastic surgeon because only after a thorough examination you will get more information and recommendations.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Joel Patrick Maier, MD · Answer

Of course, a fleur-de-lis with circumferential body lift will provide maximum 360 skin tightening if desired.  Having said that, I would think a standard type of tummy tuck skin resection will provide an excellent result. In fact, it looks like the majority of your laxity is in the mons pubis/lower tummy area so a mini-tuck may do the trick depending on your expectations. Having said that, an umbilical transposition can help but you always run the risk of a vertical scar in the lower tummy if the umbilical hole does not reach your lower transverse scar. Additionally, your muscles look tight and flat, so a traditional tummy tuck with muscle tightening can be over-treatment with all of the risk and downtime. A lower tummy skin resection +/- umbilical transposition can be done with local and minimal sedation with no drains, minimal downtime and no drains. Something to consider. Thank you for sharing.

Daniel Careaga, MD · Answer

a fleur-de-lis abdominoplasty is a form of tummy tuck in which a standard tummy tuck incision is made hidden below the bikini or underwear line and then a vertical incision was made from the upper abdomen all the way down to the lower abdomen. This is usually reserve reserved for people that have undergone massive weight loss. I always try to put myself in the position of my patience and ask myself what I would rather have: in this case the question would be a slightly tighter abdomen but a very visible scar or a mild degree of skin laxity, but in essentially invisible scar. Looking at your pictures, I would choose for myself the ladder. I do not believe that the additional degree of skin tightening that could be obtained warrants the addition of that very visible vertical scar.

Krishna Vyas, MD, PhD, MHS · Answer

The decision will be based on your goals and skin laxity.
A 360 body lift could provide excellent results - it will address the excess skin around your abdomen, hips, and back, without adding a vertical scar. This is typically a more favorable option for patients without significant vertical skin laxity above the abdomen.
The fleur-de-lis tummy tuck is often recommended when there is excess skin both horizontally and vertically, typically in cases of massive weight loss where there's a lot of sagging skin in the midline. It creates an additional vertical scar in the center of the abdomen but can provide more tightening in that specific area, especially in the waist.
If you are looking for the best contour with minimal scarring, the 360 lift may be the better choice. Discuss these options further with your plastic surgeon to help you make the most informed decision.
Krishna Vyas, MD, PhD, MHSHarvard, Hopkins, & Mayo Clinic Trained Aesthetic Plastic SurgeonNew York, New York

Stefan Mark Szczerba, MD · Answer

I would personally would not do that but I think taking a look at your preferred surgeon's outcomes may shed some light as to why there is advantage in his or her hands.  Adding scars that do not hide easily is difficult to justify -so there has to be some advantage that the surgeon should easily be able to show you.  In the meantime, do not undergo that surgery until you have better understanding.  Best Wishes!

Chet Mays, MD · Answer

Thank you for your inquiry!   The type of surgery is determined by the amount of skin laxity.  That is hard to determine in a photo.   We would love to sit down with you and discuss your options.  Schedule an appointment with a Board-Certified Plastic Surgeon to help you reach your goals.

Ira H. Rex III, MD · Answer

I would have to do an examination to give you the best advice, but from your photos it seems you could get an excellent result with an extended abdominoplasty without having the quite unaesthetic midline scar.  It depends mostly what your expectations are.  The trade-off between perhaps 20% more improvement and the vertical scar is a significant consideration.  About 20% better might just be in skin tightness, and not in overall visual correction.

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